Kristin Murphy, Deseret News
Tom Metcalf, MD and Utah Health Policy Project chair, speaks during a press conference held in reaction to the supreme court's decision to uphold Obamacare at the State Capitol Building Salt Lake City on Thursday, June 28, 2012.

During the debate on Obamacare — even the president now uses the term — supporters decried procedural delays in the Senate. "Every day that passes means higher costs and heartache for millions in need. The American people need this bill right now!" I replied, "Since the law will not go into effect until 2014, taking extra time to debate it now won't matter," but maybe I was wrong. Perhaps Administration officials could have used a few extra months to plan its implementation. Things are woefully behind schedule.

Consider the health care exchanges, which are the procedural heart of the program. The act requires every state to have one, to be established by the state itself unless it "opts out;" in that case, the exchange will be set up by the federal government. It is clear that the federal government will not be able to fulfill its responsibilities in this regard when January comes.

Some defenders of the administration say this deficiency is the result of a Republican conspiracy. "The majority of the states that have opted out have Republican governors. They did it in order to add to the federal burden, slow things down, and thus make the president look bad."

That's hard to believe. Why would a governor deliberately do something wrong for his state just to hurt a politician who can't run again? When President Obama signed the bill, he knew that the right to opt out was in it and that some states would exercise it. Surely, a contingency plan was drawn up to deal with the possibility that many would?

Apparently not. Three years later, the administration's exchanges are still not ready. It plans to install stop-gap alternatives that will last for at least a year, maybe more.

Exchanges have not been the only bump in the road on the way to Obamacare. Along with other shifts, the administration has switched positions on Medicare Advantage, a program passed by Republicans which Obamacare repealed on grounds that, well ... I never quite understood why. The White House now says that portions of Medicare Advantage will be kept, by executive order.

Add to that the new cost estimates that show that many Americans will pay higher premiums just to keep what they have while other employees, who were assured that they could keep what they have, are discovering that they won't be allowed to. Consider the number of doctors who are retiring to avoid dealing with the uncertainties and complexities of the law. The emerging picture is that of an Administration capable of passing laws but not of effectively implementing them.

The growing grumbling is bipartisan. Joe Klein of Time Magazine, no Republican apologist, is scathing in his critique: "Obamacare will fail if [the president] doesn't start paying attention to the details of implementation, if he doesn't start demanding action. And, in a larger sense, the notion of activist government will be in peril ... if institutions like the VA and Obamacare don't deliver the goods."

Complicating matters for the president is the fact that Obamacare remains as unpopular as it was when it was signed. That surprises many Democratic political advisers, including Bill Clinton. They were sure that once it became law and voters found out what was in it — it does contain many things which many Americans like — opposition would turn into support. Since that hasn't happened, implementation problems will be resented even more.

If he is to avoid bipartisan demands for a major overhaul of his "signature achievement," President Obama has a lot of work to do in the next nine months.

Robert Bennett, former U.S. Senator from Utah, is a part-time teacher, researcher and lecturer at the University of Utah's Hinckley Institute of Politics.